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1.
Euro Surveill ; 29(6)2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38333937

Resumo

The monoclonal antibody nirsevimab was at least 70% effective in preventing hospitalisations in infants with lower respiratory tract infections (LRTI) positive for respiratory syncytial virus (RSV) in Spain (Oct 2023-Jan 2024), where a universal immunisation programme began late September (coverage range: 79-99%). High protection was confirmed by two methodological designs (screening and test-negative) in a multicentre active surveillance in nine hospitals in three regions. No protection against RSV-negative LRTI-hospitalisations was shown. These interim results could guide public-health decision-making.


Assuntos
Anticorpos Monoclonais Humanizados , Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Infecções Respiratórias , Lactente , Humanos , Espanha/epidemiologia , Antivirais/uso terapêutico , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Infecções por Vírus Respiratório Sincicial/epidemiologia , Hospitalização , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/epidemiologia , Hospitais
2.
Artif Organs ; 46(5): 867-877, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34780090

Resumo

BACKGROUND: Age over 70 years seems to confer poor prognosis for patients under mechanical circulatory support (MCS). Advanced age is usually a relative contraindication. Our objective was to assess the impact of age on survival of patients with short-term MCS. METHODS: Retrospective analysis of ≥70-year-old patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP® due to cardiogenic shock and other situations of hemodynamic instability in a referral hospital (elderly group), compared with younger patients (<70 years). We analyze factors associated with survival in elderly group. RESULTS: Out of 164 short-term MCS implants from 2013 to October 2020, 45 (27.4%) correspond to ≥70-year-old patients (73.3% VA-ECMO; 26.7% Impella CP®), 80% as bridge to recovery and 15.6% for high-risk percutaneous coronary intervention (PCI). We found no significant differences in complications developed between both groups. Survivals at discharge (40% vs. 43.7%, p = 0.403) and at follow-up (median 13.6 [30] months) were similar in elderly and young patients (35.6% vs. 37.8%, log-rank p = 0.061). Predictive factors of mortality in elderly patients were peripheral artery disease (p = 0.037), higher lactate (p = 0.003) and creatinine (p = 0.035) at implant, longer cardiac arrest (p = 0.003), and worse post-implantation left ventricular ejection fraction (p = 0.003). Patients with indication of MCS for high-risk PCI had higher survival compared to other indications (p = 0.013). CONCLUSION: Short-term MCS with VA-ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high-risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.


Assuntos
Coração Auxiliar , Intervenção Coronária Percutânea , Idoso , Coração Auxiliar/efeitos adversos , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Estudos Retrospectivos , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
3.
Rev Argent Microbiol ; 54(2): 81-94, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34509309

Resumo

Although multiple attempts have been made to mathematically model the current epidemic of SARS-CoV-2, the causative agent of coronavirus disease 2019 (COVID-19), few models have been conceived as accessible interactive tools for users from various backgrounds. The goal of this study was to develop a model that took into account the heterogeneity in contact rates within the population and to implement it in an accessible application allowing to estimate the impact of possible interventions based on available information. An extended version of the Susceptible-Exposed-Infected-Resistant (SEIR) model, named SEIR-HL, was developed, assuming a population divided into two subpopulations, with different contact rates. Additionally, a formula for the calculation of the basic reproduction number (R0) for a population divided into n subpopulations was proposed, where the contact rates for each subpopulation can be distinguished according to contact type or context. The predictions made by SEIR-HL were compared to those of SEIR, showing that the heterogeneity in contact rates can dramatically affect the dynamics of simulations, even when run from the same initial conditions and with the same parameters. SEIR-HL was used to predict the effect on the epidemic evolution of the displacement of individuals from high-contact positions to low-contact positions. Lastly, by way of example, SEIR-HL was applied to the analysis of the SARS-CoV-2 epidemic in Argentina and an example of the application of the R0 formula was also developed. Both the SEIR-HL model and an R0 calculator were computerized and made available to the community.


Assuntos
COVID-19 , Pandemias , Número Básico de Reprodução , COVID-19/epidemiologia , Suscetibilidade a Doenças/epidemiologia , Humanos , Pandemias/prevenção & controle , SARS-CoV-2
4.
Eur J Clin Invest ; 51(11): e13591, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34002363

Resumo

BACKGROUND AND OBJECTIVES: Elevated troponin T (cTnT) values are associated with comorbidities and early mortality, in both cardiovascular and noncardiovascular diseases. The objective of this study is to evaluate the prognostic accuracy of the sole utilization of prehospital point-of-care cardiac troponin T to identify the risk of early in-hospital deterioration, including mortality within 28 days. METHODS: We conducted a prospective, multicentric, controlled, ambulance-based, observational study in adults with acute diseases transferred with high priority by ambulance to emergency departments, between 1 January and 30 September 2020. Patients with hospital diagnosis of acute coronary syndrome were excluded. The discriminative power of the predictive cTnT was assessed through a discrimination model trained using a derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on a validation cohort. RESULTS: A total of 848 patients were included in our study. The median age was 68 years (25th-75th percentiles: 50-81 years), and 385 (45.4%) were women. The mortality rate within 28 days was 12.4% (156 cases). The predictive ability of cTnT to predict mortality presented an area under the curve of 0.903 (95% CI: 0.85-0.954; P < .001). Risk stratification was performed, resulting in three categories with the following optimal cTnT cut-off points: high risk greater than or equal to 100, intermediate risk 40-100 and low risk less than 40 ng/L. In the high-risk group, the mortality rate was 61.7%, and on the contrary, the low-risk group presented a mortality of 2.3%. CONCLUSIONS: The implementation of a routine determination of cTnT on the ambulance in patients transferred with high priority to the emergency department can help to stratify the risk of these patients and to detect unknown early clinical deterioration.


Assuntos
Deterioração Clínica , Serviços Médicos de Emergência , Mortalidade Hospitalar , Troponina T/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ambulâncias , Área Sob a Curva , Doenças Cardiovasculares/sangue , Doenças do Sistema Digestório/sangue , Feminino , Humanos , Infecções/sangue , Masculino , Pessoa de Meia-Idade , Mortalidade , Doenças do Sistema Nervoso/sangue , Testes Imediatos , Intoxicação/sangue , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC , Doenças Respiratórias/sangue , Ferimentos e Lesões/sangue , Adulto Jovem
5.
Artif Organs ; 45(7): 717-725, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33377185

Resumo

Weaning failure and mortality rates in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) supported patients are significant. Small studies suggest the possible usefulness of levosimendan in this environment, especially in postcardiotomy shock. We performed a retrospective analysis of VA-ECMO implants in a referral hospital comparing weaning failure and survival of patients treated with levosimendan with a control group. From 2013 to May 2020, 123 VA-ECMO for several indications were implanted. Levosimendan was administered in 23 patients (18.7%) with good tolerance. Levosimendan was used more frequently in cardiogenic shock due to acute coronary syndrome indication, and in patients with lower left ventricular ejection fraction (LVEF) at the implant. No significant differences were found in success of ECMO weaning (60.9% levosimendan group vs. 44% non-levosimendan group, P = .169) despite worse LVEF in levosimendan group. Survival at follow-up (20.6 [58] months) was higher in the group that received levosimendan, although without finding statistically significant differences (47.8% vs. 32.0%, log rank P = .124). Levosimendan can be safely administered during VA-ECMO support. Patients receiving levosimendan were weaned similarly from circulatory support despite worse LVEF. Its use did not influence in short- and medium-term survival. Randomized studies are needed to evaluate the levosimendan impact in this indication.


Assuntos
Cardiotônicos/uso terapêutico , Oxigenação por Membrana Extracorpórea , Simendana/uso terapêutico , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Cardiogênico/mortalidade , Choque Cardiogênico/terapia
6.
Sensors (Basel) ; 21(4)2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33671174

Resumo

Communication systems that work in jeopardized environments such as space are affected by soft errors that can cause malfunctions in the behavior of the circuits such as, for example, single event upsets (SEUs) or multiple bit upsets (MBUs). In order to avoid this erroneous functioning, this kind of systems are usually protected using redundant logic such as triple modular redundancy (TMR) or error correction codes (ECCs). After the implementation of the protected modules, the communication modules must be tested to assess the achieved reliability. These tests could be driven into accelerator facilities through ionization processes or they can be performed using fault injection tools based on software simulation such as the SEUs simulation tool (SST), or based on field-programmable gate array (FPGA) emulation like the one described in this work. In this paper, a tutorial for the setup of a fault injection emulation platform based on the Xilinx soft error mitigation (SEM) intellectual property (IP) controller is depicted step by step, showing a complete cycle. To illustrate this procedure, an online repository with a complete project and a step-by-step guide is provided, using as device under test a classical communication component such as a finite impulse response (FIR) filter. Finally, the integration of the automatic configuration memory error-injection (ACME) tool to speed up the fault injection process is explained in detail at the end of the paper.

7.
Rev Esp Enferm Dig ; 113(12): 825-832, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34157846

Resumo

INTRODUCTION: abnormal liver biochemistry (ALB) is correlated with increased clinical involvement or severity in COVID-19, but its prognostic implications have not been studied extensively. The aim of this study was to determine whether ALB is a risk factor for unfavorable clinical outcome and involvement. MATERIALS AND METHODS: a retrospective, single-center study in confirmed COVID-19 cases. Patients with pharmacological hepatotoxicity or liver diseases were excluded. ALB was defined as any elevation of total bilirubin, AST, ALT, alkaline phosphatase, and/or GGT above the upper limit of normal. First, an assessment was made of the correlation between ALB and need for hospitalization. This was followed by an assessment of the correlation of ALB in hospitalized patients with demographic variables, comorbidities, and treatment for COVID-19, and with clinical involvement and outcome. The statistical analysis was performed using an age-adjusted multiple logistic regression with a p-value < 0.05. RESULTS: of 1,277 confirmed cases, 346 required hospitalization and 302 were included. The prevalence of ALB was higher in hospitalized patients compared to non-hospitalized patients (60.9 % vs. 10.3 %, p ˂ 0.001). Among hospitalized patients, there was no correlation between ALB and demographic variables, comorbidities, or treatment for COVID-19, except for low molecular weight heparin. There was a significant correlation between ALB and moderate/severe COVID-19 involvement and between unfavorable clinical outcomes and elevated total bilirubin. The period of greatest clinical worsening and deterioration of liver biochemistry parameters occurred during the first seven days. There was a significant correlation of ALB with longer hospital stay and admission to the intensive care unit, but this did not imply increased mortality. CONCLUSIONS: ALB correlates with greater clinical involvement and worse clinical outcomes in hospitalized patients with COVID-19.


Assuntos
COVID-19 , Hospitalização , Humanos , Fígado , Prognóstico , Estudos Retrospectivos , SARS-CoV-2
8.
Int J Mol Sci ; 20(19)2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31597315

Resumo

Iodinated contrast media (CM) are the leading cause of acute renal failure of toxic origin. Between 21% and 50% of patients that receive them develop contrast-induced nephropathy (CIN). All prophylactic measures used so far have failed to provide effective prevention. Since oxidative stress is involved in the damage, a possible preventive strategy could be the administration of antioxidant substances, such as quercetin. This compound has shown renoprotective effects in experimental studies. The aim of this study was to evaluate whether quercetin may be helpful in preventing CIN in patients undergoing coronary catheterization. A clinical phase II study was conducted. Patients were distributed in two groups, namely, CM (patients who only received contrast media) and CM+Q (patients who were pretreated with quercetin orally for 3-5 days). Results showed less incidence of CIN in the CM+Q group, possibly due to glomerular protection, evidenced by a lower increase in serum creatinine and albuminuria; and a lower decrease in the glomerular filtration rate (GFR). Furthermore, in this group, the relative risk of developing CIN observed in patients that received a high dose of contrast media was inferior. In conclusion, this is the first study that demonstrates that quercetin is a promising safe candidate in preventing CIN.


Assuntos
Meios de Contraste/efeitos adversos , Nefropatias/etiologia , Nefropatias/prevenção & controle , Substâncias Protetoras/farmacologia , Quercetina/farmacologia , Idoso , Biomarcadores , Meios de Contraste/administração & dosagem , Meios de Contraste/classificação , Creatinina/metabolismo , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Nefropatias/diagnóstico , Nefropatias/metabolismo , Masculino , Substâncias Protetoras/uso terapêutico , Quercetina/uso terapêutico
9.
Org Biomol Chem ; 14(16): 3906-12, 2016 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-27035271

Resumo

The combination of a 1,3-ketoenol system and two pyridine molecules attached as sulfonamide and carboxamide to a benzofuran skeleton allows the preparation of a novel chiral receptor for zwitterionic phenylalanine association. Interestingly, no crown-ether, urea or guanidinium are necessary to carry out the extraction of amino acids from the aqueous solution, which constitutes a breakthrough in comparison with other receptors for zwitterionic amino acid extraction.


Assuntos
Fenilalanina/química , Espectroscopia de Ressonância Magnética , Modelos Moleculares
11.
Parasit Vectors ; 17(1): 281, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38951858

Resumo

BACKGROUND: Abiotic factors play a significant role in the evolution of Leishmania infantum infection due to its vectorial nature. This study aims to assess the evolution in the detection of new L. infantum infection cases in Valdeorras (Ourense, Northwestern Spain) over a 20-year period and how different climatic variables and preventive measures may have affected it. METHODS: Indirect immunofluorescence antibody tests (IFAT) were performed on serum samples collected from dogs attending the 'Servicios Veterinarios de Sil' veterinary clinic (Valdeorras, Northwestern Spain) between May 2003 and April 2023 to detect L. infantum exposure. The percentage of new cases of L. infantum infection was calculated from May of one year to April of the following year. Climatic conditions in the region, global sales of ectoparasiticides and the number of vaccines against L. infantum delivered in the veterinary clinic from 2003 to 2022 were recorded. Statistical analyses were conducted to determine the associations between these factors and the percentage of new cases of L. infantum infection. RESULTS: A total of 2909 dogs were assessed, and 3785 IFAT tests were performed between May 2003 and April 2023. The mean percentage of new seropositive cases over the 20-year period studied was 21.65 ± 10.8%, with a decline from the beginning to the end of the period studied. The percentage was significantly higher between May 2003 and April 2008 compared with the other periods (May 2008 to April 2013, May 2013 to April 2018 and May 2018 to April 2023). There was a positive correlation between the percentage of new cases of L. infantum infection and the maximum relative humidity in winter. Conversely, there was a negative correlation between the percentage of new cases and sales of ectoparasiticides and vaccination against L. infantum. CONCLUSIONS: This study is one of the longest evaluations of the evolution of L. infantum infection in a fixed location and its association with external factors including climatic conditions and preventive measures. The results confirm that Valdeorras is a high-risk area for L. infantum infection. The use of ectoparasiticides and vaccines against L. infantum has been shown to play a significant role in preventing L. infantum infection, highlighting the crucial role of veterinarians in the fight against this disease.


Assuntos
Clima , Doenças do Cão , Leishmania infantum , Leishmaniose Visceral , Cães , Animais , Espanha/epidemiologia , Doenças do Cão/parasitologia , Doenças do Cão/epidemiologia , Doenças do Cão/prevenção & controle , Leishmania infantum/imunologia , Leishmania infantum/isolamento & purificação , Leishmaniose Visceral/veterinária , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/prevenção & controle , Leishmaniose Visceral/parasitologia , Anticorpos Antiprotozoários/sangue , Masculino , Técnica Indireta de Fluorescência para Anticorpo , Feminino
12.
Haematologica ; 98(3): 437-43, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22899581

Resumo

Allogeneic hematopoietic stem cell transplantation recipients have an increasing risk of both hemorrhagic and thrombotic complications. However, the competing risks of two of these life-threatening complications in these complex patients have still not been well defined. We retrospectively analyzed data from 431 allogeneic transplantation recipients to identify the incidence, risk factors and mortality due to thrombosis and bleeding. Significant clinical bleeding was more frequent than symptomatic thrombosis. The cumulative incidence of a bleeding episode was 30.2% at 14 years. The cumulative incidence of a venous or arterial thrombosis at 14 years was 11.8% and 4.1%, respectively. The analysis of competing factors for venous thrombosis revealed extensive chronic graft-versus-host disease to be the only independent prognostic risk factor. By contrast, six factors were associated with an increased risk of bleeding; advanced disease, ablative conditioning regimen, umbilical cord blood transplantation, anticoagulation, acute III-IV graft-versus-host disease, and transplant-associated microangiopathy. The development of thrombosis did not significantly affect overall survival (P=0.856). However, significant clinical bleeding was associated with inferior survival (P<0.001). In allogeneic hematopoietic stem cell transplantation, significant clinical bleeding is more common than thrombotic complications and affects survival.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Hemorragia/epidemiologia , Hemorragia/etiologia , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Adulto , Feminino , Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Análise de Sobrevida , Transplante Homólogo , Adulto Jovem
13.
Data Brief ; 50: 109617, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37808543

Resumo

Glioblastoma, a highly aggressive primary brain tumor, is associated with poor patient outcomes. Although magnetic resonance imaging (MRI) plays a critical role in diagnosing, characterizing, and forecasting glioblastoma progression, public MRI repositories present significant drawbacks, including insufficient postoperative and follow-up studies as well as expert tumor segmentations. To address these issues, we present the "Río Hortega University Hospital Glioblastoma Dataset (RHUH-GBM)," a collection of multiparametric MRI images, volumetric assessments, molecular data, and survival details for glioblastoma patients who underwent total or near-total enhancing tumor resection. The dataset features expert-corrected segmentations of tumor subregions, offering valuable ground truth data for developing algorithms for postoperative and follow-up MRI scans.

14.
Eur J Haematol ; 89(3): 250-5, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22642978

Resumo

BACKGROUND: Few studies have evaluated the risk of pregnancy-related adverse events in asymptomatic relatives of probands for VTE and factor V Leiden or the G20210A variant. The antepartum management of this population ranges from antepartum anticoagulation therapy to clinical surveillance. OBJECTIVE: To evaluate the risk of placenta-mediated pregnancy complications and pregnancy-related VTE in VTE-asymptomatic families of probands with VTE and who are heterozygous carriers of either factor V Leiden or PT-G20210A mutation. METHODS: One hundred and fifty-eight relatives, who had 415 pregnancies, were retrospectively evaluated. Odds ratios and 95% confidence intervals were calculated to compare pregnancy outcomes between women with and without thrombophilia. RESULTS: In the factor V Leiden group, 22 placenta-mediated pregnancy events of 152 pregnancies (14.4%) were reported, compared with 25 adverse events of 172 pregnancies in the G20210A prothrombin group (14.5%) and 13 adverse events of 91 pregnancies in the non-carrier group (14.2%). Carriers of factor V Leiden or G20210A prothrombin were not associated with a higher risk of pregnancy-adverse outcomes compared with non-carriers: OR 1.02 (95% CI, 0.40-2.25) and 1.25 (95% CI, 0.48-3.24), respectively. Four episodes of pregnancy-associated VTE of 415 pregnancies (0.96%) were recorded. Two episodes of VTE in the G20210A group, one in the factor V Leiden group, and one episode in the non-carrier group were noted. CONCLUSIONS: In VTE-asymptomatic relatives of probands with VTE, the presence of factor V Leiden or the G20210A prothrombin mutation in heterozygosis should not lead to a decision to instigate antepartum prophylaxis.


Assuntos
Fator V/genética , Heterozigoto , Mutação , Placenta/fisiopatologia , Complicações Hematológicas na Gravidez/fisiopatologia , Protrombina/genética , Tromboembolia Venosa/complicações , Feminino , Humanos , Gravidez , Complicações Hematológicas na Gravidez/genética , Tromboembolia Venosa/genética
15.
Semin Respir Crit Care Med ; 33(3): 220-31, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22718208

Resumo

The outcome of community-acquired pneumonia (CAP) depends on the interaction between the infectious agent and the host response. Nowadays the etiology of CAP can be established in ~60% of the cases, and Streptococcus pneumoniae remains the main etiological agent in outpatients, those hospitalized, or those requiring intensive care unit (ICU) admission. Recently, the development of nucleic acid amplification techniques has emphasized the role of viruses as important etiological agents in CAP. However, some demographic factors and comorbidities will determine a higher risk of pneumonia. Thus elderly patients or those with toxic habits (smoking, alcohol abuse), and the presence of various comorbidities (respiratory, metabolic, or renal) favor the development of pneumonia by altering the inflammatory response to infection.Some medications like inhaled corticosteroids could play a role in CAP development in chronic obstructive pulmonary disease (COPD) patients. Fortunately some of these risk factors are preventable and modifiable, for example, through smoking cessation and pneumococcal and influenza vaccinations, which are the biggest successes.


Assuntos
Vacinas Pneumocócicas/uso terapêutico , Pneumonia Pneumocócica/prevenção & controle , Pneumonia Viral/virologia , Pneumonia/microbiologia , Streptococcus pneumoniae/imunologia , Administração por Inalação , Corticosteroides/efeitos adversos , Fatores Etários , Consumo de Bebidas Alcoólicas , Antiasmáticos/efeitos adversos , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/prevenção & controle , Humanos , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Orthomyxoviridae/imunologia , Pneumonia/prevenção & controle , Pneumonia Viral/prevenção & controle , Fatores de Risco , Fatores Sexuais , Fumar
16.
Am J Crit Care ; 31(6): 483-493, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36316178

Resumo

BACKGROUND: Weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) support fails in 30% to 70% of patients. OBJECTIVE: To explore the utility of echocardiographic parameters in predicting successful disconnection from VA-ECMO. METHODS: Patients receiving VA-ECMO in a referral hospital were included. The relationships between echocardiographic parameters during the weaning trial and weaning success (survival > 24 hours after VA-ECMO explant and no death from cardiogenic shock, heart failure, or cardiac arrest during the hospital stay) and survival were evaluated. RESULTS: Of 85 patients included, 61% had successful weaning. Parameters significantly related to weaning success were higher left ventricular ejection fraction (LVEF; 40% in patients with weaning success vs 30% in patients with weaning failure, P = .01), left ventricular outflow tract velocity time integral (15 cm vs 11 cm, P = .01), aortic valve opening in every cycle (98% vs 91% of patients, P = .01), and normal qualitative right ventricular function (60% vs 42% of patients, P = .02). The LVEF remained as an independent predictor of weaning success (hazard ratio, 0.938; 95% CI, 0.888-0.991; P = .02). An LVEF >33.4% was the optimal cutoff value to discriminate patients with successful weaning (area under the curve, 0.808; sensitivity, 93%; specificity, 72%) and was related to higher survival at discharge (60% vs 20%, P < .001). CONCLUSION: Among weaning trial echocardiographic parameters, LVEF was the only independent predictor of successful VA-ECMO weaning. An LVEF >33.4% was the optimal cutoff value to discriminate patients with successful weaning and was related to final survival.


Assuntos
Oxigenação por Membrana Extracorpórea , Humanos , Volume Sistólico , Função Ventricular Esquerda , Choque Cardiogênico/terapia , Ecocardiografia , Estudos Retrospectivos
17.
Nutrients ; 13(5)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068354

Resumo

Lockdown during the COVID-19 pandemic imposed changes in children's daily routine that could lead to changes in behavior patterns. Using a survey targeted at children under 17 years of age, we described dietary (adherence to Mediterranean diet, AMD) and sleeping habits (disorders of initiating and maintaining sleep) after the implementation of lockdown, and examined the probability of the inadequate frequency of physical activity (PA) and use of TV and electronic devices (TV-ED) before and after lockdown through generalized estimating equation models, accounting for age and gender differences. From 3464 children included, 53.2% showed optimal AMD; 79.2% referred to delayed bedtime; and 16.3% were suspected of sleeping disorders after the implementation of lockdown. Delay in bedtime was more frequent among children older than 6 years, and inadequate sleeping hours among those younger than 11 years. There were no gender differences in AMD or sleeping habits. The odds of inadequate frequency of PA and TV-ED use were greater after lockdown, with a greater risk for TV-ED use. Boys were at greater risk of inadequate PA frequency and TV-ED use. Odds ratio of inadequate PA was greater at older ages. Lockdown could influence changes in children's habits that could lead to risk factors for non-communicable diseases during adulthood if such behaviors are sustained over time.


Assuntos
COVID-19/epidemiologia , Saúde da Criança , Hábitos , Doenças não Transmissíveis/epidemiologia , Pandemias , Obesidade Infantil/epidemiologia , SARS-CoV-2 , Adolescente , Criança , Pré-Escolar , Exercício Físico , Feminino , Humanos , Masculino , Espanha/epidemiologia
18.
Front Psychol ; 10: 2284, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31649596

Resumo

The implementation of the European higher education area (EHEA) is a true paradigm change in university education in which the student, with particular consideration given to autonomous work, takes the place of the teacher as the central element of the teaching-learning process. In this autonomous work, the strategies the students regularly use become particularly important, given the supposition that doing that work will lead to academic success. The objective of this study is to analyze the variables that influence students' expectations of success, measured through their intention to persist on the course they are doing. A questionnaire designed ad hoc was given to a sample of 1037 university students. It included aspects related to reasons for choosing the course, institutional integration, use of self-regulation strategies, and intention to drop out. Data analysis allowed the identification of satisfaction with the course chosen and appropriate study skills acquired in secondary education as predictors of expectations of academic persistance, with some differences in terms of gender. Other strategies such as class attendance or going deeply into course content did not figure. These results are at odds with the principles underlying the EHEA and show that they have not yet been interiorized by the students, who continue to perceive their studies more traditionally.

19.
Arch Bronconeumol ; 44(10): 531-9, 2008 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-19006633

Resumo

OBJECTIVE: In this study, we assessed factors associated with cardiovascular risk in patients with sleep apnea-hypopnea syndrome (SAHS) through analysis of plasma concentrations of N-terminal prohormone brain natriuretic peptide (NTproBNP) and high-sensitivity C-reactive protein (hsCRP). In addition, we analyzed the effect of nasal continuous positive airway pressure (nCPAP) on these markers. PATIENTS AND METHODS: Forty-two patients with SAHS (mild to moderate in 15 cases and severe in 27) were compared with 14 individuals without SAHS. The participants were not receiving drug treatment and they did not have diabetes, hypertension, marked dyslipidemia, or cardiovascular disease, which was ruled out both clinically and by echocardiography and (99m)Tc-tetrofosmin scintigraphy at rest and during exercise. The effects of nCPAP in patients with severe SAHS were analyzed after 6 months of treatment. RESULTS: Following adjustment for age, body mass index, and smoking habit, the mean concentrations of markers were not significantly higher in patients with severe SAHS than in those with mild-to-moderate SAHS or in control subjects. Nevertheless, in patients with SAHS the main factor influencing NTproBNP concentrations was the percentage of time with a nocturnal arterial oxygen saturation of less then 90% (r=0.37, P=.017). No variables predictive of hsCRP concentration were identified. The concentrations of the markers were reduced by nCPAP, but the differences were not statistically significant. CONCLUSIONS: While nocturnal hypoxemia in SAHS is responsible for variations in the plasma concentration of NTproBNP (as a result of cardiovascular changes), SAHS appears not to be associated with the inflammatory marker hsCRP when patients with heart disease, cardiovascular risk factors, or those receiving pharmacologic treatment are excluded.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Hemodinâmica , Síndromes da Apneia do Sono/terapia , Adulto , Proteína C-Reativa/análise , Feminino , Humanos , Inflamação/sangue , Inflamação/complicações , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Síndromes da Apneia do Sono/sangue , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/fisiopatologia
20.
J Am Heart Assoc ; 7(19): e009444, 2018 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-30371302

Resumo

Background Ticagrelor use during acute coronary syndromes demonstrated a decrease in all-cause mortality in the PLATO (Platelet Inhibition and Patient Outcomes) trial. This effect has been attributed to a non-platelet-derived improvement in endothelial function. The aim of this study was to determine differences in the number of endothelial progenitor cells and/or circulating endothelial cells found in peripheral blood in patients treated with either ticagrelor or clopidogrel during non-ST-segment-elevation myocardial infarction. Methods and Results In this multicenter, randomized study ( NCT 02244710), patients were considered for inclusion after non-ST-segment-elevation myocardial infarction whenever they were P2Y12-inhibitor naïve. Ticagrelor and clopidogrel were allocated at a 1:1 ratio. Blood samples for determining endothelial progenitor cells and circulating endothelial cells were extracted before the antiplatelet loading dose, 48 hours after presentation of index symptoms, and 1 month after the event. A multichannel cytometer was used for optimal cell characterization. A total of 96 patients fulfilled the inclusion criteria. Circulating endothelial cell levels corrected by white blood cells were as follows at baseline, 48 hours, and 1 month: 44 (28-64), 50 (33-63), and 38 (23-62) cells/mL, respectively, for clopidogrel and 38 (29-60), 45 (32-85), and 35 (24-71) cells/mL, respectively, for ticagrelor ( P=0.6). Endothelial progenitor cell levels were 29 (15-47), 27 (15-33), and 18 (10-25) cells/mL, respectively, for clopidogrel and 20 (11-33), 22 (12-32), and 18 (11-29) cells/mL, respectively, for ticagrelor ( P=0.9). No differences in intraindividual changes were found. Conclusions Patients treated with ticagrelor during non-ST-segment-elevation myocardial infarction, in comparison to clopidogrel, showed similar levels of endothelial progenitor cells and circulating endothelial cells. These data suggest that the endothelial protective effect mediated by ticagrelor is not related to bone marrow physiology modulation. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT 02244710.


Assuntos
Clopidogrel/administração & dosagem , Células Progenitoras Endoteliais/metabolismo , Endotélio Vascular/fisiopatologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/tratamento farmacológico , Ticagrelor/administração & dosagem , Vasodilatação/fisiologia , Idoso , Eletrocardiografia , Células Progenitoras Endoteliais/citologia , Feminino , Seguimentos , Humanos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/metabolismo , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Inibidores da Agregação Plaquetária/administração & dosagem , Prognóstico , Método Simples-Cego
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